CHAPTER IV
CURABILITY OF INSANITY.

INSANITY, when uncomplicated, properly and promptly treated, and having this treatment duly perservered in, may be regarded as curable as most other serious diseases; but its curability mainly depends upon these conditions. Of the class of cases alluded to, it is safe to say that about as many as eighty per cent. may be expected to recover. Where cases of insanity are left without proper treatment, they rarely get well, but are more apt to sink into some form of dementia, and to be for life a source of anxiety and a charge upon their friends or the community.

In all discussions in regard to the character of insanity and its curability, it is important that it should be placed in the same category as other diseases. It is just as possible for any one to have an attack of insanity, to recover from it, and to have another attack at a subsequent period of life, as it is of any other disease, or as any one is liable to have a first attack. It would be quite as reasonable to say that a patient with fever or rheumatism, or dysentary, or any other affection that he may have had in a past year, had not recovered from either of them, because from some cause (understood or not as the case might be) he had suffered from another attack of the same disorder in the same year or in subsequent years, as to insist that any one who had had an attack of insanity, and who had been relieved of every symptom of it, had not been cured, because at some later period of life, from some cause or other, he had another attack of the same disease. Whenever an individual suffering from insanity, is relieved from all indications of mental unsoundness, returns to his home and family without any developed eccentricity, resumes his ordinary relations with society, attends to his business with his usual ability and intelligence, for a year, or even a much less period, there should be no hesitation in recording such a case as "cured," without any reference to the future, about which we can know nothing. There is no power to insure any case, or to say that there may never be another attack. No one has a right to assert that a combination of circumstances, like that which produced the first, may not cause another; that ill health, and commercial revulsions, and family sorrows, and the many other causes that may have originally developed the disorder, may not again bring on a return of the same symptoms, just as they may produce them in one who has never before been insane. Out of seven thousand eight hundred and sixty-seven consecutive cases in the author's observation, five thousand six hindred and ninety-five had never had an attack before. Whatever induced the disease in them, certainly may induce it in those who have already suffered from the same malady, for we cannot expect one attack of insanity to act as a prophylactic, and like measles or smallpox to give immunity for the future.But this new attack is no evidence that the patient was not cured of the previous one. If the patient, then, is well in the sense in which he is considered well from an attack of typhoid fever, or dysentary, or rheumatism, or a score of other maladies,—when another attack is developed, it is as much a new case, and the recovery is a cure, just as much as it would be if he suffered from any other form of illness, and it ought to be so recorded. If he does not recover, in the sense in which a recovery has already been described, he should not be recorded as cured. Insanity uncured does really tend to shorten the duration of life, because individuals thus afflicted do not resist attacks of other diseases as well as the sane, and there are often great difficulties in carrying out a proper form of treatment.